微创医学

目的探讨V-Loc缝线在腹腔镜下子宫肌瘤切除术中应用的安全性及有效性。方法回顾性研究151例行腹腔镜下子宫肌瘤切除术的子宫肌壁间肌瘤患者的临床资料，将其分为普通可吸收薇乔线缝合组（对照组）60例及V-Loc缝线缝合组（研究组）91例。各组分别采用不同缝合技巧：连续褥式缝合（褥式法）和连续棒球式缝合（棒球法）。观察两组患者的术中出血量、手术时间、术后发热时间、住院时间，于术后第2天复查血红蛋白（Hb），并计算与术前Hb值的差值；术后3个月复查B超了解术后肌瘤残留率；随访2～5年，记录最终成功妊娠者的妊娠结局；记录两组患者的术后并发症情况。结果151例均完成腹腔镜手术，无一例中转开腹及术后发生并发症。研究组患者的手术时间短于对照组(P＜0.05)，而两组术中出血量、Hb下降量、发热时间、住院时间比较，差异均无统计学意义（均P＞0.05）。研究组中棒球法的手术时间、术中出血量、术后Hb下降量均明显低于褥式法，对照组中棒球法的术中出血量、术后Hb下降量均明显低于褥式法(均P＜0.05)。术后3个月复查 B 超均无肌瘤残留。随访2～5年，51例患者成功妊娠，均无子宫破裂或先兆子宫破裂发生。结论腹腔镜子宫肌瘤切除术中应用V-Loc缝线及应用棒球法安全可靠，且手术时间短，术中出血少，值得推广应用。

ObjectiveTo investigate the safety and efficacy of V-Loc suture on laparoscopic myomectomy. MethodsThe clinical data of 151 patients with intramural hysteromyoma undergoing laparoscopic myomectomy were retrospectively studied. The patients were divided into common absorbable Vicryl suture group (control group, n=60) and V-Loc suture group (study group, n=91). Different suture techniques were used for each group, including continuous mattress suture (mattress suture) and continuous baseball suture (baseball suture). The intraoperative blood loss, operation time, postoperative fever time, and hospital stays were observed in the two groups. Hemoglobin (Hb) was reexamined on the second day after operation, and the difference between the reexamined value and preoperative value was calculated. B-scan ultrasonography was performed to determine the residual rate of postoperative myoma 3 months after the operation. Follow-up was conducted for 2-5 years to record the pregnancy outcomes of the final successful pregnancies, and to record the postoperative complications in both groups. ResultsAll 151 patients completed laparoscopic surgery, with no conversion to open surgery, and no occurrence of postoperative complications. The operation time of the study group was shorter than that of the control group (P＜0.05), while there were no statistically significant differences between the two groups in intraoperative blood loss, Hb decrease, fever time, and hospital stays (all P＞0.05). In the study group, the operation time, intraoperative blood loss, and postoperative Hb decrease of the baseball suture were significantly lower than those of the mattress suture. In the control group, the intraoperative bleeding volume and the amount of Hb decrease after the baseball suture were significantly lower than those after the mattress suture (all P＜0.05). No myoma residual 3 months after operation. During the 2-5 years of follow-up, no uterine rupture or premonitory uterine rupture occurred in 51 patients with successful pregnancy. ConclusionV-Loc suture and baseball suture are safe in laparoscopic myomectomy, following short operation time and less intraoperative blood loss, which is worthy of promotion and application.